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2nd Trimester: The Ultimate Guide to Pregnancy Issues

2nd Trimester: The Ultimate Guide to Pregnancy Issues

Your 2nd Trimester

When you hit the 2nd trimester, your nausea should be diminishing, your appetite is coming back, and you get a boost of energy. It’s fantastic! On the other side of things, your hormones are peaking, which means you're going to have more bloating and more gas. Some of my patients say, 'In the morning my tummy is still flat, but by the end of the day I look really pregnant!' It’s not your baby that’s changing; it’s that your increased progesterone is trapping food and gas in your belly. Let’s look at what other issues might emerge in your second trimester.


The second trimester is when you’ll start noticing some changes in your sleep. Starting at 20 weeks, the uterus really starts gaining volume, and if you sleep on your back, the uterus will be laying on top of your vena cava and can diminish blood flow back to the heart, making you lightheaded and dizzy.

How to soothe it:

  • I tell my patients to sleep on their side, and on the left side if possible. Sleeping on the left side helps keep the uterus from sitting on your liver and also improves circulation to the heart and allows for the best blood flow to the fetus, uterus, and kidneys.
  • This isn’t to say you should freak out if you wake up in the morning, and you’re on your back. You’ll be fine, but just try to make sure you always start the night on your side.

Urinary Tract Infections (UTIs)

Urinary tract infections are super common throughout pregnancy, including the second trimester. Part of it has to do with your physiology and the way the uterus changes the pelvic anatomy. And similar to the acid reflux we discussed earlier, your hormones are relaxing the muscles around your urinary system, so you're more prone to having a little bit of urinary reflux back up into the urethra. They’re also more common because being pregnant means you’re in a bit of an immunocompromised state, so it’s harder, in general, for you to fight infections. UTI symptoms are similar to others you’re experiencing in pregnancy, so UTI symptoms are often confused with the symptoms of pregnancy. At my practice, like most, we’re checking for them at each visit, and we’re proactive about treatment.

How to soothe it:

  • Research shows—though we don’t 100% understand why—that drinking cranberry juice or taking cranberry pills may help prevent UTIs. That said, I don’t use cranberry products to treat a UTI; they don’t replace antibiotics.
  • If you think you might have a UTI, check with your OB/GYN. If you test positive, they’ll most likely prescribe an antibiotic. Antibiotics work by killing the bacteria that are causing the infection, but that means they’re also inadvertently killing the good bacteria in your gut. To replenish the good bacteria, I recommend taking a probiotic. I’m a big fan of probiotics to reestablish your gut microbiome in general. You can either take a probiotic supplement or by eating yogurt that’s fortified with probiotics. If you don’t do either, your good gut bacteria will repopulate on their own, but it can take several months.

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Constipation is a really common symptom that typically begins early in the second trimester. Again, it’s due to progesterone slowing everything down. The good news is this protects the baby and helps you absorb the nutrients your body needs. But the bad news is it also means you're absorbing more water from your gut, and so you end up having harder, more frequent stools.

How to soothe it:

  • If constipation is a concern, I usually recommend a diet rich in fiber. I also recommend you talk to your OB/GYN. They might suggest an over-the-counter stool softener.
  • I also recommend that women increase their water intake during pregnancy to two-to-three liters a day. It can be hard to get that in every day but have it as a goal.
  • You should also look at other changes you’ve made that may be contributing to constipation. Exercise helps keep you regular, so if you’ve cut back, look at adding more movement to your day. Also, caffeine helps with bowel regularity, so if you’ve cut back on that, it may be a contributor. If you don’t want to add more caffeine back to your diet, try my first two tips.

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Leg Cramps

Leg cramps are caused by multiple factors. It can sometimes signal a lack of calcium. I always tell my patients, 'You're making a person, and those little embryos will take everything from the mother. They absorb all the calcium they can.' And particularly now, people are drinking less 'real' milk, so it can be hard to get calcium in your diet unless you're intentional about it.

How to soothe it:

  • Calcium helps diminish leg cramps (and also helps with reflux). To get more calcium through food, try cheese, almonds, or yogurt, which may also help with pregnancy constipation. Also, look at adding bananas to your diet for a magnesium boost.

You’re almost there!

Go to Dr. Fiss’s guide to Trimester 3!
By Caitlin Fiss, MD

This site is intended for informational purposes only and does not provide medical advice. Please consult your physician or other health-care professional.

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